Periprosthetic infections after total shoulder arthroplasty: a 33-year perspective

doi:10.1016/j.jse.2012.01.006

Journal of Shoulder and Elbow Surgery

Volume 21, Issue 11, November 2012, Pages 1534-1541

https://doi.org/10.1016/j.jse.2012.01.006 Get rights and content

Background

To examine the rates and predictors of deep periprosthetic infections after primary total shoulder arthroplasty (TSA).

Methods

We used prospectively collected data on all primary TSA patients from 1976-2008 at Mayo Clinic Medical Center. We estimated survival free of deep periprosthetic infections after primary TSA using Kaplan-Meier survival. Univariate and multivariable Cox regression was used to assess the association of patient-related factors (age, gender, body mass index), comorbidity (Deyo-Charlson index), American Society of Anesthesiologists class, implant fixation, and underlying diagnosis with risk of infection.

Results

A total of 2,207 patients, with a mean age of 65 years (SD, 12 years), 53% of whom were women, underwent 2,588 primary TSAs. Mean follow-up was 7 years (SD, 6 years), and the mean body mass index was 30 kg/m² (SD, 6 kg/m²). The American Society of Anesthesiologists class was 1 or 2 in 61% of cases. Thirty-two confirmed deep periprosthetic infections occurred during follow-up. In earlier years, Staphylococcus predominated; in recent years, Propionibacterium acnes was almost as common. The 5-, 10-, and 20-year prosthetic infection–free rates were 99.3% (95% confidence interval [CI], 98.9-99.6), 98.5% (95% CI, 97.8-99.1), and 97.2% (95% CI, 96.0-98.4), respectively. On multivariable analysis, a male patient had a significantly higher risk of deep periprosthetic infection (hazard ratio, 2.67 [95% CI, 1.22-5.87]; P = .01) and older age was associated with lower risk (hazard ratio, 0.97 [95% CI, 0.95-1.00] per year; P = .05).

Conclusions

The periprosthetic infection rate was low at 20-year follow-up. Male gender and younger age were significant risk factors for deep periprosthetic infections after TSA. Future studies should investigate whether differences in bone morphology, medical comorbidity, or other factors are underlying these associations.

Section snippets

Methods

We used the Mayo Clinic Medical Center Total Joint Registry, which prospectively captures data on every shoulder arthroplasty since the surgery was performed at the Mayo Clinic, Rochester, Minnesota, USA, beginning in 1976. Our study cohort consisted of every adult aged 18 years or older with primary TSA performed at the Mayo Clinic Medical Center, Rochester, in a 33-year period from 1976-2008.

We identified all patients with periprosthetic infections (deep or superficial) using the

Results

During the study period 1976-2008, 2,207 patients underwent 2,588 primary TSAs. The mean age was 65 years (SD, 12 years), and 53% of patients were women. Mean follow-up was 7 years (SD, 6 years; range, 1 day to 31 years), with follow-up censored at revision arthroplasty (patients were followed up only until the occurrence of revision surgery). The mean BMI was 30 kg/m² (SD, 6 kg/m²); the ASA grade was 1 or 2 in 61% of cases and 3 or 4 in 39%. Other characteristics of the population are shown in

Discussion

In our study the rate of deep periprosthetic infection risk was low in TSA patients with a high infection-free survival rate of 97% at 20-year follow-up. Men were significantly more likely and older patients were significantly less likely to have deep periprosthetic infections after TSA. We noted some change in etiopathogenesis of deep periprosthetic infection over a 33-year period, with Propionibacterium recognized more commonly as the causative organism for periprosthetic infections in the

Conclusion

We found a low risk of deep periprosthetic infection after TSA in a follow-up of up to 20 years. Staphylococcus and Propionibacterium were the most common organisms associated with deep periprosthetic infections after TSA. Two patient factors, male gender and younger age, were risk factors for deep periprosthetic infections. Further studies are needed to investigate the underlying reasons for these differences by studying these and additional factors, such as bone characteristics, implant

Disclaimer

This material is the result of work supported by National Institutes of Health Clinical Translational Science Award 1 KL2 RR024151-01 (Mayo Clinic Center for Clinical and Translational Research) and the resources and the use of facilities at the Birmingham VA Medical Center, Birmingham, Alabama, USA.

There are no financial conflicts related to this work. J.A.S. has received speaker honoraria from Abbott; research and travel grants from Allergan, Takeda, Savient, Wyeth, and Amgen; and consultant

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Retrospective chart review was conducted for patients diagnosed with PJI after primary shoulder arthroplasty between January 2010 and August 2021. Patients were included if they underwent treatment with DAIR, single-stage revision, or 2-stage revision. Demographic information, surgical details, complications, laboratory data, postoperative antibiotic regimen, and infectious pathogen were collected. Postoperative patient-reported outcomes were collected: American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, Single Assessment Numeric Evaluation, Shoulder Activity Scale, and PROMIS Upper Extremity. Chi-square, t test, and 1-way analysis of variance were used as appropriate to evaluate each factor.
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Patients undergoing treatment of shoulder PJI with DAIR did not have an increased rate of reinfection compared with single-stage and 2-stage revision procedures. Patients treated with DAIR were diagnosed with PJI significantly earlier than those undergoing single-stage and 2-stage revision procedures. There was no difference in complication rates between groups. This information adds to the body of work detailing outcomes after DAIR for shoulder PJI and provides encouraging data for use in this patient population. Future studies with a larger sample size may be conducted to further investigate specific pathogens, infection timelines, and antibiotic regimens that reduce the risk of treatment failure.
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: This study was approved by the Mayo Clinic's Institutional Review Board, and all investigations were conducted in conformity with ethical principles of research.

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ShoulderPeriprosthetic infections after total shoulder arthroplasty: a 33-year perspective

Background

Methods

Results

Conclusions

Section snippets

Methods

Results

Discussion

Conclusion

Disclaimer

J Shoulder Elbow Surg

J Chronic Dis

J Chronic Dis

J Shoulder Elbow Surg

J Clin Epidemiol

J Shoulder Elbow Surg

J Arthroplasty

Infection associated with hematoma formation after shoulder arthroplasty

Clin Orthop Relat Res

Shoulder
Periprosthetic infections after total shoulder arthroplasty: a 33-year perspective